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Thursday, November 1

More About Frozen Shoulder

Frozen shoulder happens when inflammation develops inside the shoulder joint.  Frozen shoulder is also called “adhesive capsulitis”.  The inflammation from frozen shoulder causes pain at first, but over time causes thickening of the ligaments inside the shoulder.  This thickening of the ligaments is similar to the formation of a scar.  As this occurs, the shoulder becomes progressively more stiff.  This process occurs slowly over many months.  Most people start to notice that they can’t put their hand behind their back, to put on a bra or put a wallet in the back pocket.  Pain at night is very common, and throwing or reaching above the head become difficult or impossible.  We don’t know why frozen shoulder happens, but it is more common in patients with diabetes or thyroid problems.  Sometimes it starts as the result of a minor injury.  Most often, though, it begins for no reason at all. 

It is not always possible to tell the difference between pain from frozen shoulder or pain from arthritis, bursitis, or tendonitis.  Only your physician can make a definitive diagnosis.

The good news is that frozen shoulder is not a permanent problem.  It will always get better on its own, but slowly, over many months.  It can take up to one or two years for the pain to completely go away and the shoulder motion to return to normal.  Most people don’t want to wait a year for the symptoms to clear up.  So what can be done?

In my practice, I usually start with cortisone shots.  Since the problem is related to inflammation, and cortisone is a powerful anti-inflammatory, cortisone shots help most people get past the worst of the pain and stiffness.  These injections are done with the help of an ultrasound machine, which guides the injection into the correct spot.  Most people will have significant relief of pain with cortisone injections.  Some people, though, may continue to experience stiffness even if the pain improves.

Patients with persistent stiffness sometimes benefit from a simple surgical procedure called a “manipulation and release”.  This procedure is done under general anesthesia.  First, the shoulder is gently stretched to break up the scar tisuue.  Then, through small “arthroscopic” incisions about one-half inch long, the inside of the shoulder is cleaned up and the tight scar tissue is removed.  Most patients recover fully from this surgery within 6 weeks, although it may take longer.  The results are generally very good.

To summarize, frozen shoulder is a problem of inflammation in the shoulder.  It results in pain and stiffness, and is treated with cortisone injections.  If cortisone shots don’t work, then a simple arthroscopic surgical procedure may help. 

Monday, October 15

Release for Frozen Shoulder

Here I perform a release for a frozen shoulder.  Frozen shoulder is a condition that can be a result of injury, but often happens for no reason at all.  It can occur in anyone, but is more common in people with diabetes and thyroid problems.  A closed manipulation (seen here) is performed to break up the tight, inflamed tissue that causes the shoulder to be "frozen".  By breaking up this tight scar tissue, the shoulder mobility is greatly improved.

Thursday, October 11

Do I Need Surgery for my Torn Rotator Cuff?

Let's start with this: you have shoulder pain, and have seen a doctor about it. The doctor orders an MRI, and it shows a tear in the rotator cuff. You might then ask: will the tear heal on its own? do I need surgery?

First things first: Will a torn rotator cuff tendon heal on its own? We actually know the answer to this, and the answer is no. Tears in the rotator cuff do not heal with time. Studies show that even years after a tear is discovered, repeat MRI scans show there is no evidence of healing.

So we know the torn tendon doesn't heal.  Does this mean that I have to have surgery!?   If you want the tendon to heal, then the answer to this question is yes.  But consider this: many people live their entire lives with a tear in the rotator cuff, with no problems, and no or minimal pain.  So it is possible to live with a tear and do just fine.

In my practice, I generally recommend surgery for patients younger than 50 years old.  Between 50 and 65, it really depends on the patient: active people who need their shoulder for work or recreational activities should strongly consider surgery.   For patients over 65, I recommend surgery as a last resort, only if therapy and injections aren't helpful.

In summary, torn rotator cuff tendons do not heal and I recommend surgery for most patients younger than 65, especially those younger than 50.  Some patients older than 65 do well without surgery.

For more information about rotator cuff repair, see my previous blog posts.

Thursday, August 23

Live Shoulder Surgery Event

Me and Drew Osika  at the live surgery event yesterday
Thanks to those who participated in our live surgery event, held at Apollo Surgical in Brentwood, Missouri.  We'll be having more live surgery events in the coming months.    SSM Physical Therapy and Apollo Surgical co-sponsored the event.

Shoulder Replacement

I recently filmed a new video of a shoulder replacement surgery.  Shoulder replacement is an excellent option for patients who have severe arthritis and persistent pain.  Shoulder replacement is also an option for some patients with large rotator cuff tears.   Many patients with shoulder replacement will have no pain after surgery, while others will have a significant decrease in their pain.  Most patients will have increased strength and motion, as well.  There are risks to shoulder replacement.  If you have been told that you need a shoulder replacement, it is worth having a detailed discussion with your surgeon about the potential benefits but also the risks.

Wednesday, July 4

Dr. Frisella's Practice Intro Video


The Barnes Hospital system produced this short video about my shoulder surgery practice, which includes interviews with some of my patients.  A heartfelt thank you to the people who took time out of their day to make this video possible.  Seeing patients talk about their results is a nice reminder of why I do what I do.

Missouri Division of Workers' Compensation Meeting

We had a great turnout for my talk last month at the Missouri Division of Workers' Compensation Annual Meeting.  I spoke about impairment and disability, and how I assign disability ratings in my practice.  I used videos to illustrate how I assess loss of strength and motion.  Generally, most patients who have a surgically repaired rotator cuff or labral tear will have about 5% permanent loss of strength and motion in their shoulder.  That means that, in the long term, they will get back about 95% of their "normal" strength and motion. 

Thursday, May 3

Say Goodbye to Shannon!

Many of my patients know my medical assistant Shannon Donati, who has been an integral part of my practice since 2007.  If you've been to see me, you've seen Shannon--wallking you in, explaining procedures, setting up tests and surgeries.  After five years of outstanding service to my patients, Shannon is moving on to a supervisor role at St. Peters Bone and Joint Surgery.  We will miss her! 

Thursday, March 1

Golf and Your Shoulder

Typical golf swing:
Notice the wide range of motion of the left shoulder
A shoulder injury is the second most common golfing injury (back injuries are the most common).  It might be a surprise to know that right-handed golfers have an increased risk of injury to the left shoulder.  That's because the left shoulder travels through a long motion during the swing, moving back with the backswing and forward with the follow-through.  This swinging motion puts strain on the rotator cuff and can cause tendonitis and bursitis.

If you shoulder is bothering you, what can you do?  My advice to most patients is first to take a week or two off.  If that doesn't work, then try to shorten your swing.  Try a shorter swing first at the driving range with your irons.  If that goes well and you can swing without pain, then move on to playing nine holes with only your irons.  If at any point pain returns, stop, take a week off, then try again.  If things don't improve, see a shoulder doc.

Happy golfing!

Thursday, February 16

Teaching at the Orthopedic Surgery Annual Meeting

My mentors Drs. Peter McCann and Fran Cuomo asked me to help teach a course on arthroscopic rotator cuff repair at the American Academy of Orthopedic Surgery Annual Meeting in San Franisco last week.  Great chance for me to reconnect with my shoulder surgery teachers and help others learn at the same time. 

Here's the course description:

Thursday, January 19

Simple Shoulder Exercises

Many shoulder problems will improve with simple exercises.  Nick Weber from Excel Physical Therapy was nice enough to volunteer to put together a brief video demonstrating a very basic set of five exercises that often help with many types of shoulder pain related to inflammation.  In my experience, about 75% of patients improve significantly with physical therapy.  Just a note:  if your pain is severe or the diagnosis is not known, consult a physician!

New Website

Check out the new website at